Conversion of sleeve gastrectomy to Roux-en-Y gastric bypass in patients with gastroesophageal reflux disease: results of a multicenter study.

Abstract Background The main side effect of long-term laparoscopic sleeve gastrectomy (LSG) is the onset of severe gastroesophageal reflux disease (GERD). Objectives The aim of this study was to evaluate the effectiveness of gastric bypass conversion in controlling post-sleeve GERD. Setting University Hospital and Private Hospital, France; Private Hospital, Italy. Methods This retrospective multicenter study included patients who underwent LSG and suffered from postoperative GERD, who did not respond to medical treatment and were converted to laparoscopic Roux-en-Y gastric bypass (LRYGB). The study involved two French university hospitals, four French private centers, and an Italian public hospital. Results A total of 80 patients were reviewed. Treatment of a hiatal hernia was performed during LSG in three patients, while 19 patients were operated for hiatal hernia during conversion to bypass (p = 0.0004). Six months after surgery, 23 of the 80 patients maintained reflux symptomatology with a daily frequency, for which continued proton pump inhibitor treatment was required. The persistence of GERD was significantly more frequent among patients with previous gastric banding (n = 19) compared to patients with no history of gastric banding (n = 4, p = 0.02). In other words, the likelihood of having poor clinical success from conversion of the sleeve to bypass due to intractable GERD was three times higher if the patient had a history of gastric banding (relative risk = 2.89, odds ratio = 3.69). Conclusion The results of this study show that, despite the conversion, the symptomatology of GERD does not always disappear, especially in patients with previous gastric banding.